Employment Application

Your Information

EHS does not discriminate on the basis of race, religion, color, national origin, age, veteran, family status, sex, or sexual identity.

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* 1. Which office are you applying for?

Lynchburg

Martinsville

Roanoke

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* 2. Position applying for:

MHSS Clinician

MHS Team Leader

Clinical Coordinator

Office Manager

SA Program Manager

SA Counselor

SA Case Manager

Physician Level (Physician, Nurse Practitioner, Physician Assistant)

Other

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* 3. How did you hear of this position?

Indeed

EHS Website

Facebook

Current Employee

Craigslist

Other (please specify)

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* 4. Contact Information

Full Name *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

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* 5. Date you're available to start work:

Date

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* 6. Available:

Full-time

Part-time

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* 7. Do you have relatives working for EHS?

Yes

If yes, please list:

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* 8. Have you ever been employed by EHS?

Yes

If yes, when?

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* 9. If you have worked for EHS under another name, please list name(s):

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* 10. Do you have the legal right to work in the U.S.?
Note: If hired, proof of identity and authorization to work in the U.S. will be required.

Yes

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* 11. Will you now or in the future require sponsorship for employment visa status?

Yes

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* 12. If applying for a position that requires driving a personal vehicle, do you have a valid license and proof of insurance?

Yes

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* 13. EHS Driver Safety Policy requires a motor vehicle record check for all employees who drive vehicles for related position duties. Do you have any driving offenses on your record?

Yes

If yes, give details. (offense, place of occurrence, date, penalty) below.

Note: Convictions are not an automatic bar to employment. Each case is considered on its individual merits and the position for which you have applied. However, false statements or material omissions will result in not being hired or terminated from employment.

Question Title

* 1. Which office are you applying for?

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* 2. Position applying for:

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* 3. How did you hear of this position?

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* 4. Contact Information

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* 5. Date you're available to start work:

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* 6. Available:

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* 7. Do you have relatives working for EHS?

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* 8. Have you ever been employed by EHS?

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* 9. If you have worked for EHS under another name, please list name(s):

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* 10. Do you have the legal right to work in the U.S.? Note: If hired, proof of identity and authorization to work in the U.S. will be required.

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* 11. Will you now or in the future require sponsorship for employment visa status?

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* 12. If applying for a position that requires driving a personal vehicle, do you have a valid license and proof of insurance?

Question Title

* 13. EHS Driver Safety Policy requires a motor vehicle record check for all employees who drive vehicles for related position duties. Do you have any driving offenses on your record?

* 10. Do you have the legal right to work in the U.S.?
Note: If hired, proof of identity and authorization to work in the U.S. will be required.